Claim rules · Article 2 of 4
Creating a claim rule
Claim rules are created from the claim rules screen, which you reach from a customer's or supplier's profile. The form is the same in both cases — the only difference is which field gets pre-filled when you arrive.
Before you start
You need the claim_rule.create permission to create rules. If New Claim Rule is not visible on the claim rules screen, ask your team administrator to check your role permissions.
If you are copying rules from an existing support plan rather than building a new one from scratch, use the Transfer from plan mode instead — see Transferring claim rules between plans.
Open the new claim rule form
The entry point depends on whether the rule is scoped to a customer, a supplier, or both. Either path leads to the same form.
Two entry points to the claim rules screen. 1 On a customer profile, View claim rules sits inside the More… dropdown alongside other "view" actions. 2 On a supplier profile, it appears as a direct link in the sidebar action area, between View invoices and View history. Selecting either link opens the claim rules screen pre-filtered to that customer or supplier.
- Open the relevant profile Find the customer or supplier the rule should apply to, and open their profile page.
- Select View claim rules On a customer profile, open the More… menu and select View claim rules. On a supplier profile, select View claim rules directly from the sidebar.
- Click New Claim Rule Select New Claim Rule in the top-right of the claim rules screen. The form opens with Create new selected, and your customer or supplier is pre-filled.
The form at a glance
The create form is one scrolling page with five distinct sections: the mode toggle, the customer/supplier scope, claim rule groups, support categories and items, and the date range. Below is what you'll see with an empty form for a customer who has at least one support plan.
Choose customers or suppliers, then add line items by group, category, or individual support item.
Claim rule groups
Selecting a group pulls in its line items and uses the group name as the reason. Removing any of those items switches the rule to a manual reason.
Support categories and items
Add or fine-tune individual items. These selections always need a reason.
Date range
The new claim rule form, opened from a customer profile. 1 The Create new / Transfer from plan toggle sits at the top of the form. 2 The mandatory Type field, followed by the Supplier and Customer scope fields. 3 The claim rule groups section — selecting a group fills the reason automatically. 4 Support categories and items, with the Reason field above the two multi-selects. 5 The date range section with Use support plan dates ticked.
Step 1 — Choose the rule type
Select a value in the Type dropdown. This field is required and determines what happens when an invoice matches the rule.
| Option | Effect on a matching invoice |
|---|---|
| Warning | A flag is raised on the invoice. The team can still process it, but must acknowledge the flag. |
| Authorized | The invoice is explicitly permitted — overrides flags or blocks that would otherwise trigger. |
| Blocked | The invoice is blocked from being processed until the rule is resolved or removed. |
Step 2 — Select a customer and/or supplier
Use the Supplier and Customer fields to scope the rule. At least one must be selected; if you leave both blank, saving will fail with the error "You must select a customer, supplier or both".
- Supplier only — applies to all invoices from that supplier, for any customer.
- Customer only — applies to all invoices for that customer, from any supplier.
- Both — applies only when that specific customer–supplier combination appears on an invoice.
Step 3 — Add support items
A rule with no items specified applies to all NDIS support items on matching invoices. To narrow that down, use any combination of the three methods below — they all add items to the same selection.
Method 1 — Use claim rule groups
Claim rule groups are pre-built bundles of NDIS support items maintained by Kismet. They're the fastest way to apply a standard set of items.
- Search for a group In the Claim rule groups field with placeholder "Add line items using authorised claim rule groups", type to filter — e.g. "Standard CORE" or "Continence". Select the group from the dropdown.
- Items load automatically All items in the group are added to the selection. The group's name is used as the rule's reason and the Reason field becomes optional.
- Fine-tune if needed You can remove individual items afterwards. If you do, the rule switches to a manual reason and you must enter one in the Reason field — the hint changes to "Required if you remove any items that came from a group."
Method 2 — Add by support category
Use the Add line items using support categories field to pull in every item from one or more NDIS support categories. Pick categories from the dropdown; each one expands into its constituent items.
Method 3 — Add items individually
Use the Add line items individually field to type a support item number or keyword and select specific items from the search results.
Step 4 — Set the date range
Every rule needs a date range. Navigator only applies the rule to invoices whose dates fall within this range.
If you selected a customer in Step 2 and they have at least one support plan, the Use support plan dates checkbox appears. You then have two options:
| Option | What happens |
|---|---|
| Tick Use support plan dates | A Support plan dropdown appears, listing all the customer's support plans formatted as "{plan name} (start – end)". Pick a plan and Navigator locks the rule's dates to that plan's start and end dates. A blue info alert confirms the dates. |
| Leave it unticked | Two date inputs appear instead — Start date and End date. Enter dates manually. |
If you selected a supplier only (no customer), the checkbox doesn't appear — only the manual Start date and End date inputs are shown.
Step 5 — Review and save
Before saving, scroll down to the Selected items summary at the bottom of the form. If items are selected, two alert panels may appear:
- A blue info alert listing the items that will have rules created.
- A yellow warning alert listing items that already have active rules and will be skipped.
The submit button's text changes based on how many rules will be created:
| Selected items | Submit button label |
|---|---|
| None (rule applies to all items) | Create Claim Rule |
| 1 item | Create Claim Rule |
| 5 items | Create Claim 5 Rules |
Select the button to save. Navigator creates a separate claim rule for each new item (skipping any already covered) and returns you to the claim rules screen, where the new rules appear at the top of the list. To cancel without saving, select Cancel at the bottom-left of the form.